Provider Demographics
NPI:1700758497
Name:SHUE, PAW TA
Entity type:Individual
Prefix:
First Name:PAW
Middle Name:TA
Last Name:SHUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 N TRIPHAMMER RD STE 11
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1093
Mailing Address - Country:US
Mailing Address - Phone:607-227-4421
Mailing Address - Fax:607-463-0602
Practice Address - Street 1:2415 N TRIPHAMMER RD STE 11
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1093
Practice Address - Country:US
Practice Address - Phone:607-227-4421
Practice Address - Fax:607-463-0602
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030590225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics